Pre Existing Conditions?

Off Topic Politics & World Issues
41

[quote]TheBodyGuard wrote:

[quote]horsepuss wrote:
Im dealing with a situation like this right now.My wife got laid off december of 08, she then started some schooling and collecting unemployment.She was on cobra for a while but it was expensive so she discontinued.My insurance at work has open enrolement every june and we waived adding her then because it is 400 dollars a month as opposed to 76 for just me.

Well in october she got pregnant with no insurance.Since then I have tried everything to get her added on to my insurance because my program doesnt consider pregnancy a pre existing condition but they turned us down because its not during the enrolement window.

We have tried to look into getting state assistance but apparently I make to much money which is news to me.She is now interning at a dentist but there insurance program considers pregnancy a pre existing condition.

So fuck us, we were both born in this country and have never commited a felony or anything close, we pay our taxes and doing everything we are supposed to but hey we got pregnant without it being planned so we are shit out of luck.The shitty thing is and this is gonna piss alot of you off but I dont care, if we were mexican or some unemployed african americans on welfare we wouldnt be paying for shit, most likely we would be getting grants and sent to college.[/quote]

I understand your frustration but what I don’t understand is your logic. How is it that you did “everything you were supposed to”? First, you and your wife made a conscious decision to go uninsured. You decided to accept a risk. Next, you again, of your own collective volition, decided to go uninsured yet again when you skipped the open enrollment period at your job. You had an “unplanned” pregnancy. Frankly, I don’t see much difference there than some border jumper or teenager getting pregnant. You know you have sex correct? I assume no contraception, or reliable contraception was in play correct? I think all of the foregoing is indisputable, yet you claim you do “everything you were supposed to”. So let’s sum it up: twice you made a decision not to insure your wife. You had unprotected sex and she became pregnant (sincere congratulations - circumstances notwithstanding). Now you are reaping the result of the risk you knowlingly accepted on TWO ocassions.

What am I missing?[/quote]

My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

42

[quote]borrek wrote:

[quote]Vegita wrote:
I’m with BG on this one. How can you expect insurance (i.e. Other People) to pay for your wifes pregnancy, when you DECIDED to not participate in the coverage, and thus not pull your own weight.

Guess what, I went uninsured for 2 months this past year, it was a calculated descision. My wife had much cheaper insurance kicking in (she started a job at a hospital) and I could save a couple hundred bucks per month by dropping myself. Well not one day after my insurance ended, I feel a bump on my gum right below one of my back molars. Yep I got an abcessed tooth. It was my own fault and guess what I did, I paid for a dentist visit out of pocket to assess how serious it was and if I could wait the 2 months. They said other than pain, as long as it was draining I should be safe. So I dealt with it. Now I have a gold tooth and look cool to boot. Not that that is relevant.

V[/quote]

Wait wait wait…back the truck up.

Did you pay out of pocket for the gold tooth, and dentist visit to have the abscess taken care of (not just an assessment)? If not, then you had a pre-existing condition, flew under the radar when getting re-insured, had the pre-existing abscess fixed under insurance, and then started a thread about how you don’t want to be saddled paying for pre-existing conditions?

Just checking.
[/quote]

Where in the hell have you been?
And why is some guy licking your nipple?

43

throw the idea of tort reform out the window. i want the threat of litigation hanging over my doctor’s head when he cuts me open. further, tort reform saves insurance companies money and these savings will not be passed on to the consumer.

you know what controls cost? cutting out the hundreds of millions of dollars the executives of health insurance companies make in aggregate.

in sum, when health insurance companies control their own costs, market forces don’t magically reduce prices. it takes active effort on the part of insurance companies to reduce their prices.

44

[quote]thefederalist wrote:
throw the idea of tort reform out the window. i want the threat of litigation hanging over my doctor’s head when he cuts me open. further, tort reform saves insurance companies money and these savings will not be passed on to the consumer.

you know what controls cost? cutting out the hundreds of millions of dollars the executives of health insurance companies make in aggregate.

in sum, when health insurance companies control their own costs, market forces don’t magically reduce prices. it takes active effort on the part of insurance companies to reduce their prices. [/quote]

You actually believe tort reform means making doctors and insurance companies invulnerable to lawsuits? Do you know that doctors pay something like a quarter of a million a year just for liability insurance?

This isn’t about completely eliminating the risk of lawsuits. Just the bullshit ones. Too many lawyers have turned the laws into methods of picking peoples pockets. Not what it was intended, which is exactly what you are wanting.

The quarter of a million that the doctors have to pay each year must get paid somehow, and you know exactly where it is going to come from. The patients.

If a doctor screws up, he should definitely pay. But why are they having to pay when, for example the wonderful lawsuits brought by John Edwards where he made doctors pay for causing Cerebral Palsy, when research shows that this is not caused by doctors, and that there is nothing a doctor could do about it.

But millions were paid out. For the benefit of the family? No to line the pockets of Lawyers. The families troubles, and their urge to place blame, was used. They were manipulated.

This is what tort reform is about.

45

[quote]horsepuss wrote:

My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

[/quote]

Right.

46

[quote]borrek wrote:

[quote]Vegita wrote:
I’m with BG on this one. How can you expect insurance (i.e. Other People) to pay for your wifes pregnancy, when you DECIDED to not participate in the coverage, and thus not pull your own weight.

Guess what, I went uninsured for 2 months this past year, it was a calculated descision. My wife had much cheaper insurance kicking in (she started a job at a hospital) and I could save a couple hundred bucks per month by dropping myself. Well not one day after my insurance ended, I feel a bump on my gum right below one of my back molars. Yep I got an abcessed tooth. It was my own fault and guess what I did, I paid for a dentist visit out of pocket to assess how serious it was and if I could wait the 2 months. They said other than pain, as long as it was draining I should be safe. So I dealt with it. Now I have a gold tooth and look cool to boot. Not that that is relevant.

V[/quote]

Wait wait wait…back the truck up.

Did you pay out of pocket for the gold tooth, and dentist visit to have the abscess taken care of (not just an assessment)? If not, then you had a pre-existing condition, flew under the radar when getting re-insured, had the pre-existing abscess fixed under insurance, and then started a thread about how you don’t want to be saddled paying for pre-existing conditions?

Just checking.
[/quote]

I am pretty sure dental is an add on that does not follow the same “rules” as far as pre existing conditions. Instead they limit your annual allowance of work that can be done to $1500. The dental portion doesn’t care if it was pre-existing or not. However, if say I broke my arm, or developed an infection while uninsured, I would have had to pay mu hospital visits and treatment out of pocket or go into debt if I could not afford them.

Also if the dentist had told me, Hey this has got to be taken care of immediately, I would have had to have the tooth extracted or root canaled and paid for it out of pocket.

And one more thing, at least in my mind, I wasn’t deciding to stay uninsured. I asked my work to take me off the health insurance in Sept, the thinking was my wifes would start up when her job started. But she had to wait for a probation period, when we found out that was the case, work had already put the request in to have me taken off. At that point I was like, hell just keep me off, it’s only going to be 2 months, what could possibly happen.

V

47

[quote]horsepuss wrote:
My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

[/quote]

In fairness to this thread, I’m not sure I have a relevant position on Haiti. I don’t see it as a good analogy either.

48

[quote]thefederalist wrote:
throw the idea of tort reform out the window. i want the threat of litigation hanging over my doctor’s head when he cuts me open. further, tort reform saves insurance companies money and these savings will not be passed on to the consumer.

you know what controls cost? cutting out the hundreds of millions of dollars the executives of health insurance companies make in aggregate.

in sum, when health insurance companies control their own costs, market forces don’t magically reduce prices. it takes active effort on the part of insurance companies to reduce their prices. [/quote]

You’re absolutely uninformed. Tort reform can stop frivolous med mal cases in their tracks. It does not stop the threat of litigation. Furthermore, there is a national data bank of reproted malpractice cases on each doctor licensed to practice. Do you know how many OB/GYNs won’t even deliver babies anymore because of the threat of frivolous litigation and junk science? Are you at all familiar with some of the birth injury verdicts? There are other professionals leaving high risk practices because of this - and this is not good for anyone. Why do they leave? They cannot afford the insurance or it is too expensive. What drives the expense? Indemnity payments and defense costs defending lawsuits.

Insurance companies cannot merely “reduce their prices”. Premium is a result of loss experience and loss ratios. You collect X amount of dollars in premium, you expect to pay less than X in claims and operating expense. The foregoing is common sense or companies would not be in business. In medical malpractice, the profits, if any, are not that high. In fact, on many lines of business, there are losses.

You are uninformed.

49

[quote]TheBodyGuard wrote:

[quote]horsepuss wrote:
My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

[/quote]

In fairness to this thread, I’m not sure I have a relevant position on Haiti. I don’t see it as a good analogy either.
[/quote]
I dont care about sensitivity, its a great analogy.

50

[quote]horsepuss wrote:

[quote]TheBodyGuard wrote:

[quote]horsepuss wrote:
My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

[/quote]

In fairness to this thread, I’m not sure I have a relevant position on Haiti. I don’t see it as a good analogy either.
[/quote]
I dont care about sensitivity, its a great analogy.
[/quote]

LOL no one accused me of being sensitive - ever. It’s not a matter of sensitivities or political correctness for I am neither. Your analogy however is terrible. You’re comparing your household decisions and a pregnancy to thousands of innocent victims who had no choice and suffered a disaster. They cannot control their government. They cannot control an act of God. And they are truly suffering.

You on the other than can completely control your household. You had two chances to insure, and both times you refused. You have control over whether you have sex and whether you use a reliable form of contraception. Your wife’s pregnancy is not a disaster, is not causing any suffering, although it may cause financial sacrafice.

She will still receieve necessary medical care (it cannot be refused). Your analogy is terrible and it’s pretty obvious and should not warrant a serious reply. You are a terrible example of someone that should bitch about healthcare. I’d think someone who works and does not have access to benefits has a better case than you.

You have access and on two separate and distinct ocassions made a decision to go bare. And apparently, you decided to go bare when you had sex with your wife :slight_smile: Entice 3 bears and something is bound to happen…

51

[quote]horsepuss wrote:

[quote]TheBodyGuard wrote:

[quote]horsepuss wrote:
My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

[/quote]

In fairness to this thread, I’m not sure I have a relevant position on Haiti. I don’t see it as a good analogy either.
[/quote]
I dont care about sensitivity, its a great analogy.
[/quote]

Accidental pregnancy = Large earthquake destroying poorly made buildings?

I can see where you’re going with this, as both were unexpected, unplanned events significantly altering a persons life.

Insurance coverage being more than you wished to pay = combined failures of multiple generations of different groups of people with different agendas.

Unless you had insurance coverage that had to be taken out 20 years ago, and needed most of the people in your community and their ancestors cooperation to take out said insurance, the analogy doesn’t work.

52

[quote]thefederalist wrote:
you know what controls cost? cutting out the hundreds of millions of dollars the executives of health insurance companies make in aggregate.

in sum, when health insurance companies control their own costs, market forces don’t magically reduce prices. it takes active effort on the part of insurance companies to reduce their prices. [/quote]

I can’t believe no one has raped the shit out of this beautiful piece of retardation yet.

Hundreds of millions? You understand that insurance companies deal with numbers in the BILLIONS right? The pay of an executive does not, never has, and never will have anything but the tiniest, insignificant impact on pricing. On the other hand, the billions that go to litigation and bureaucracy for that litigation drive costs up significantly.

Insurance companies sure as FUCK don’t control their own costs. I don’t know how the hell you got that idea. Market forces most certainly DO affect prices. To say otherwise is, quite frankly, hilarious ignorance. Companies don’t randomly pick some fucking numbers to decide how to price their products, they listen and interpret market forces and compare that to their own costs.

The fact that you think ANY firm (excluding government granted monopolies) has full control over its pricing just reveals your ignorance of very basic economic facts.

53

[quote]TheBodyGuard wrote:
You’re absolutely uninformed. Tort reform can stop frivolous med mal cases in their tracks. It does not stop the threat of litigation. Furthermore, there is a national data bank of reproted malpractice cases on each doctor licensed to practice. Do you know how many OB/GYNs won’t even deliver babies anymore because of the threat of frivolous litigation and junk science? Are you at all familiar with some of the birth injury verdicts?[/quote]

I’ll bite: How many?

[quote] There are other professionals leaving high risk practices because of this - and this is not good for anyone. Why do they leave? They cannot afford the insurance or it is too expensive. What drives the expense? Indemnity payments and defense costs defending lawsuits.

Insurance companies cannot merely “reduce their prices”. Premium is a result of loss experience and loss ratios. You collect X amount of dollars in premium, you expect to pay less than X in claims and operating expense. The foregoing is common sense or companies would not be in business. In medical malpractice, the profits, if any, are not that high. In fact, on many lines of business, there are losses.

You are uninformed.
[/quote]

The cost of malpractice insurance premiums, plus malpractice awards, plus malpractice settlements not awarded in court adds up to less than two percent of all US health care costs. (source - Congressional Budget Office, many others) If you add in defensive medicine - unnecessary tests performed solely to avoid the threat of lawsuit - the total cost related to malpractice might rise to as high as ten percent of all health care costs. (source - 2006 study by PriceWaterhouse Coopers, and anecdotes reported in Washington Examiner - AARP disagreed, using different anecdotes to suggest that doctors perform unnecessary procedures for many reasons other than simple fear of lawsuit)

If tort reform were to cut malpractice related costs in half - which seems unlikely since doctors do sometimes make mistakes and therefore still need insurance, and will still order some unnecessary tests just to satisfy cranky patients, but let’s say that it does - the best you could hope for is somewhere between a one to five percent reduction in overall health care costs, with one percent being way more likely than five percent.

Is tort reform a good idea? Absolutely. There is no reason to give any more money to lawyers than absolutely necessary.

Will medical tort reform help make health care more affordable to anyone who cannot afford it now? No, not really.

If you have some analysis that shows how tort reform would lead to a significant reduction in overall health care costs, I’d love to see it.

54

[quote]milod wrote:

[quote]TheBodyGuard wrote:
You’re absolutely uninformed. Tort reform can stop frivolous med mal cases in their tracks. It does not stop the threat of litigation. Furthermore, there is a national data bank of reproted malpractice cases on each doctor licensed to practice. Do you know how many OB/GYNs won’t even deliver babies anymore because of the threat of frivolous litigation and junk science? Are you at all familiar with some of the birth injury verdicts?[/quote]

I’ll bite: How many?

[quote] There are other professionals leaving high risk practices because of this - and this is not good for anyone. Why do they leave? They cannot afford the insurance or it is too expensive. What drives the expense? Indemnity payments and defense costs defending lawsuits.

Insurance companies cannot merely “reduce their prices”. Premium is a result of loss experience and loss ratios. You collect X amount of dollars in premium, you expect to pay less than X in claims and operating expense. The foregoing is common sense or companies would not be in business. In medical malpractice, the profits, if any, are not that high. In fact, on many lines of business, there are losses.

You are uninformed.
[/quote]

The cost of malpractice insurance premiums, plus malpractice awards, plus malpractice settlements not awarded in court adds up to less than two percent of all US health care costs. (source - Congressional Budget Office, many others) If you add in defensive medicine - unnecessary tests performed solely to avoid the threat of lawsuit - the total cost related to malpractice might rise to as high as ten percent of all health care costs. (source - 2006 study by PriceWaterhouse Coopers, and anecdotes reported in Washington Examiner - AARP disagreed, using different anecdotes to suggest that doctors perform unnecessary procedures for many reasons other than simple fear of lawsuit)

If tort reform were to cut malpractice related costs in half - which seems unlikely since doctors do sometimes make mistakes and therefore still need insurance, and will still order some unnecessary tests just to satisfy cranky patients, but let’s say that it does - the best you could hope for is somewhere between a one to five percent reduction in overall health care costs, with one percent being way more likely than five percent.

Is tort reform a good idea? Absolutely. There is no reason to give any more money to lawyers than absolutely necessary.

Will medical tort reform help make health care more affordable to anyone who cannot afford it now? No, not really.

If you have some analysis that shows how tort reform would lead to a significant reduction in overall health care costs, I’d love to see it.[/quote]

I never made the last argument. I was responding specifically to the subject of tort reform. I never connected tort reform to lower healthcare cost, but as you concluded, it would result in some reduction. The healthcare problem is a multi-faceted one and I did not warrant that I had the answers. I was merely replying on the subject of insurance and litigation, of which I am an expert at both.

55

[quote]TheBodyGuard wrote:

[quote]horsepuss wrote:

[quote]TheBodyGuard wrote:

[quote]horsepuss wrote:
My post was premeditated.I know what youre saying BG and you Vegita and youre outlook on my case is much the same on how I feel about Haiti.They could have created capitolism, free market trade and jobs creating revenue and income throughout there country which would have created funding and allowing them to create Earthquake worthy buildings, Right?

[/quote]

In fairness to this thread, I’m not sure I have a relevant position on Haiti. I don’t see it as a good analogy either.
[/quote]
I dont care about sensitivity, its a great analogy.
[/quote]

LOL no one accused me of being sensitive - ever. It’s not a matter of sensitivities or political correctness for I am neither. Your analogy however is terrible. You’re comparing your household decisions and a pregnancy to thousands of innocent victims who had no choice and suffered a disaster. They cannot control their government. They cannot control an act of God. And they are truly suffering.

You on the other than can completely control your household. You had two chances to insure, and both times you refused. You have control over whether you have sex and whether you use a reliable form of contraception. Your wife’s pregnancy is not a disaster, is not causing any suffering, although it may cause financial sacrafice.

She will still receieve necessary medical care (it cannot be refused). Your analogy is terrible and it’s pretty obvious and should not warrant a serious reply. You are a terrible example of someone that should bitch about healthcare. I’d think someone who works and does not have access to benefits has a better case than you.

You have access and on two separate and distinct ocassions made a decision to go bare. And apparently, you decided to go bare when you had sex with your wife :slight_smile: Entice 3 bears and something is bound to happen…[/quote]

“Entice 3 bears and something is bound to happen”, this is good.

56

[quote]TheBodyGuard wrote:

[quote]pittbulll wrote:

Blue cross and Blue Shield were created by Doctors and Hospitals. When they were started they were nonprofit, Blue Cross 1929[/quote]

Still, to SPREAD RISK. There are all manner and form of “insurance” - not just for profit. There are many cooperative and pooling arrangements. Still, the concept is one of spreading risk. Whether for profit or not, the insured must contribute a sum to be covered for a peril. You speak as if the original BC/BS was a social program.[/quote]

We agree, it was not quite a social program, but the intention was to help people, not to gouge the people and the Doctors for every penny they did not have to pay.

I think it has been just the recent past when the Ins. Companies took the approach that Health Ins. Was all about profit and not for the benefit of the Insured.

57

[quote]TheBodyGuard wrote:

[quote]pittbulll wrote:

[quote]horsepuss wrote:
Im dealing with a situation like this right now.My wife got laid off december of 08, she then started some schooling and collecting unemployment.She was on cobra for a while but it was expensive so she discontinued.My insurance at work has open enrolement every june and we waived adding her then because it is 400 dollars a month as opposed to 76 for just me.

Well in october she got pregnant with no insurance.Since then I have tried everything to get her added on to my insurance because my program doesnt consider pregnancy a pre existing condition but they turned us down because its not during the enrolement window.

We have tried to look into getting state assistance but apparently I make to much money which is news to me.She is now interning at a dentist but there insurance program considers pregnancy a pre existing condition.

So fuck us, we were both born in this country and have never commited a felony or anything close, we pay our taxes and doing everything we are supposed to but hey we got pregnant without it being planned so we are shit out of luck.The shitty thing is and this is gonna piss alot of you off but I dont care, if we were mexican or some unemployed african americans on welfare we wouldnt be paying for shit, most likely we would be getting grants and sent to college.[/quote]

This is one of my issues, if you are not working the Gov. Supplies excellent ins., if you are working you are penalized.[/quote]

You can’t be serious. You see the above as an example of being “penalized” when they twice opted out of available coverage??? Really?[/quote]

Letâ??s see I quit working file for welfare and get free Medical care and a monthly check and food stamps, or I could get a job that might not have medical care and might not pay enough for me to afford food or health care. Which should I choose stay at home, live a modest life or go to work and live in poverty? Oh such a tough decision.

The system is a disincentive to work…

58

[quote]Beowolf wrote:

[quote]thefederalist wrote:
you know what controls cost? cutting out the hundreds of millions of dollars the executives of health insurance companies make in aggregate.

in sum, when health insurance companies control their own costs, market forces don’t magically reduce prices. it takes active effort on the part of insurance companies to reduce their prices. [/quote]

I can’t believe no one has raped the shit out of this beautiful piece of retardation yet.

Hundreds of millions? You understand that insurance companies deal with numbers in the BILLIONS right? The pay of an executive does not, never has, and never will have anything but the tiniest, insignificant impact on pricing. On the other hand, the billions that go to litigation and bureaucracy for that litigation drive costs up significantly.

Insurance companies sure as FUCK don’t control their own costs. I don’t know how the hell you got that idea. Market forces most certainly DO affect prices. To say otherwise is, quite frankly, hilarious ignorance. Companies don’t randomly pick some fucking numbers to decide how to price their products, they listen and interpret market forces and compare that to their own costs.

The fact that you think ANY firm (excluding government granted monopolies) has full control over its pricing just reveals your ignorance of very basic economic facts. [/quote]

The argument against high salaries/bonuses has always baffled me. First, like you mentioned, the pay/bonuses will have little/no impact on the business. Second, these executives probably worked their asses off and spent a good time in school to get to where they are (reap what you sow). Third, you have to pay competitively in order to retain top talent.

How about reduce the pay of movie stars, athletes, etc.? I bet we could pool all that money for some glorious social program.

59

[quote]jo3 wrote:
How about reduce the pay of movie stars, athletes, etc.? I bet we could pool all that money for some glorious social program.[/quote]

For the love of sanity don’t give them ideas!!!

60

[quote]jo3 wrote:

[quote]Beowolf wrote:

[quote]thefederalist wrote:
you know what controls cost? cutting out the hundreds of millions of dollars the executives of health insurance companies make in aggregate.

in sum, when health insurance companies control their own costs, market forces don’t magically reduce prices. it takes active effort on the part of insurance companies to reduce their prices. [/quote]

I can’t believe no one has raped the shit out of this beautiful piece of retardation yet.

Hundreds of millions? You understand that insurance companies deal with numbers in the BILLIONS right? The pay of an executive does not, never has, and never will have anything but the tiniest, insignificant impact on pricing. On the other hand, the billions that go to litigation and bureaucracy for that litigation drive costs up significantly.

Insurance companies sure as FUCK don’t control their own costs. I don’t know how the hell you got that idea. Market forces most certainly DO affect prices. To say otherwise is, quite frankly, hilarious ignorance. Companies don’t randomly pick some fucking numbers to decide how to price their products, they listen and interpret market forces and compare that to their own costs.

The fact that you think ANY firm (excluding government granted monopolies) has full control over its pricing just reveals your ignorance of very basic economic facts. [/quote]

The argument against high salaries/bonuses has always baffled me. First, like you mentioned, the pay/bonuses will have little/no impact on the business. Second, these executives probably worked their asses off and spent a good time in school to get to where they are (reap what you sow). Third, you have to pay competitively in order to retain top talent.

How about reduce the pay of movie stars, athletes, etc.? I bet we could pool all that money for some glorious social program.[/quote]

I stand in aw of your brilliance :wink: